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Medical Peace Work Online Course 7
Prevention of interpersonal and self-directed violence
Course 7: Prevention of interpersonal and self-directed violence
General objectives:• Analyse the origin and extent of different
types of violence at the micro level.• Describe risk factors and prevention
strategies for each type.
Course 7: Prevention of interpersonal and self-directed violence
• Chapter 1: Preventing interpersonal violence
• Chapter 2: Preventing self-directed violence
Ch. 1: Preventing interpersonal violence
In this chapter you will learn:
• Outline the magnitude.• Describe the ecological
model for understanding and preventing violence.
• Describe the roles that health professionals can play.
What is violence?
Definition by World Health Organization:
Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.
(WHO, 2002:5)
Typology of interpersonal violence
(Source: WHO-Europe, adapted from WHO 2002:7)
Fatal interpersonal violence: Homicide
• 500.000 per year• 1.400 every day• Victims and perpetrators
mostly between 15-44 years
• Differences within regions: – Colombia: 146,5/100.000– Cuba: 12,6
• Differences within countries: (urban/rural, rich/poor, ethnic group)– USA: Homicide of youth (15-24 years)
• African-American: 38,6• Hispanic: 17,3• Caucasian: 3,1
(WHO 2002)
Deaths are only the tip of the iceberg
” For every death due to interpersonal violence there are perhaps hundreds more victims that survive.”
(WHO 2004:2)
Levels of non-fatal interpersonal violence
• Tens of millions of children – abused and neglected each year worldwide
• Up to 10% of males and 20% of females– report having been sexually abused as children
• For every case of homicide among young people– 20-40 non-fatal cases that require hospital care
• Rape and domestic violence– account for 5-16% of healthy years of life lost among
women of reproductive age
• 10-50% of women– experience physical violence at the hands of an intimate
partner during their lifetime (WHO 2002:9-11)
Estimates of non-fatal interpersonal violence
• Physically assaulted by an intimate partner:– Paraguay 10%– Philippines 10%– USA 22%– Canada 29%– Egypt 34%
• Ever been sexually assaulted (including attempts):– Toronto 15%– London 23%
• Involvement in physical fighting in the past year (adolescent males in secondary schools):
– Sweden 22% – USA 44%– Jerusalem/Israel 76%
(WHO 2002)
Indirect Costs
• Premature deaths• Lost productivity• Absenteeism• Economic development• Quality of life• Other intangible losses
• Premature deaths• Lost productivity• Absenteeism• Economic development• Quality of life• Other intangible losses
Direct Costs
• Medical• Mental health• Emergency response services• Law enforcement services• Judicial services
• Medical• Mental health• Emergency response services• Law enforcement services• Judicial services
Magnitude and impact
Source: WHO-Europe
Role of health professionals
Health Professionals
Victim services
Advocacy
Policy
Engaging other
sectorsResearch
Prevention
& control
Injury surveillance, evaluation
Injury surveillance, evaluation
Source: WHO-Europe
A public health approach to violence
• From problem identification to effective response
Define the problem:
Data collection, surveillance
Identify causes:
Risk factor identification
Develop and test interventions:
Evaluation research
Implement interventions, measure effectiveness:
Community intervention, training, public awareness
(Adapted from: Mercy et al. 1993)
Timing of peace work
• Primary prevention– Risk factors – Protective factors
• Secondary prevention– Early warning– De-escalation– Conflict handling
• Tertiary prevention– Reconstruction– Resolution– Reconciliation
Ecological model for understanding and preventing interpersonal violence
Interpersonal violence as complex interplay of factors
(Dahlberg and Butchart 2005:99)
Shared risk factors for interpersonal violence
• Individual:Victim of child maltreatment, personality disorder, alcohol/substance abuse, history of violent behaviour
• Relationship:Poor parenting, marital discord, low socioeconomic household, violent friends
• Community:Poverty, high crime levels, high residential mobility, high unemployment, local illicit drug trade, weak institutional policies, inadequate victim care
• Societal:Rapid social change, economic inequality, gender inequality, policies that increase inequalities, poverty, weak economic safety nets, poor rule of law, high firearm availability, war/ post-war situation, cultural violence
Violence prevention interventions with some evidence of effectiveness
Key:• Well supported by
evidence (multiple randomized controlled trials with different populations)
◦ Emerging evidence
Type of violence:- CM: Child maltreatment- IPV: Intimate partner
violence- SV: Sexual violence- YV: Youth violence- EA: Elder Abuse- S: Suicide and other
forms of self-directed violence
(WHO 2009:2)
Global Campaign for Violence Prevention
www.euro.who.int/violenceinjurywww.who.int/violence_injury
www.who.int/gender
Course 7: Prevention of interpersonal and self-directed violence
• Chapter 1: Preventing interpersonal violence
• Chapter 2: Preventing self-directed violence
Ch. 2: Preventing self-directed violence
Learning objectives:
• Outline the extent of suicide around the world and variations in its incidence.
• Describe what makes people vulnerable to suicidal behaviour.
• Evaluate interventions to tackle suicide.
Defining important concepts
• SuicideDeliberately initiated act of killing oneself, performed in full knowledge or expectation of its fatal outcome (Wasserman and Wasserman 2009)
• Attempted suicide Action where the person intentionally hurts him- or herself, with a non-fatal outcome, and the intention was to die.
• Deliberate self-harmAct where the person intentionally causes self-injury, and the act has a non-fatal outcome. -Motivation: suicide attempt or no intention of killing oneself (Hawton et al.
2006)
Statistical picture
• Deliberate self-harm– More than twice as common among females as males– About 10 % of people (Madge et al. 2008)
• Suicide– About 1 million
each year– One each 40 sec.– Male > female– Atheist >
Buddhist > Christian > Muslim
(Bertolote and Fleischman 2002)
Vulnerability to suicidal behaviour
• Family structure and history• Economic factors• Health status• Life stress• Interaction of genetic and
environmental factors
Treating suicidal people and people who self-harm
• Problem-solving therapy • Intensive psychological therapy • Community outreach and increased
intensity of care • Pharmacological treatment
Other important resources:– Care and support of family, friends, social networks and
social care professionals– Health professionals can help to access these resources.
Preventing suicide
1. Education and awareness programmes for the public and professionals
2. Screening programmes for those at high risk3. Treatment of psychiatric disorders4. Restrictions on access to lethal means5. Media reporting guidelines for suicide
(Mann et al. 2005)
• Primary prevention- population-wide interventions
• Secondary prevention- focus on high-risk groups
References
• Bertolote J, Fleischmann A (2002). A global perspective in the epidemiology of suicide. Suicidology 359:835-840.
• Dahlberg L, Butchart A (2005). Violence prevention efforts in developing and developed countries. International Journal of Injury Control and Safety Promotion 12(2):93-104.
• Hawton K, Rodham K (2006). By their own young hand. Deliberate self- harm and suicidal ideas in adolescents. Jessica Kingsley Publishers, London and Philadelphia.
• Madge N et al. (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of child psychology and psychiatry, 49:6, 667 677.
• Mann J et al. (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294(16).
• Wasserman D, Wasserman C (2009). Oxford textbook of suicidology and suicide prevention. A global perspective. Oxford University Press.
• WHO (2002). World report on violence and health. Geneva, WHO. • WHO (2004). Preventing violence: a guide to implementing the recommendations
of the world report on violence and health.• WHO (2009). Violence prevention – the evidence. Geneva, WHO.
© medicalpeacework.org 2012Author Klaus Melf, editor Mike Rowson, graphic design Philipp Bornschlegl